The truth is more complicated: A man facing treatment should prepare himself for the probability of ED. But while typical, ED is not inevitable. And any man who develops it can still enjoy great sex — including deeply satisfying orgasms — as long as he is willing to stop viewing an erection as a prerequisite.
Most treatments are equally effective
Assuming annual checkups, prostate cancer is likely to be diagnosed early, before it has spread outside the gland. Early detection means a good prognosis: The American Cancer Society estimates there were 239,000 new diagnoses of prostate cancer in 2013, but only 30,000 deaths — a death rate of 13 percent. (By comparison, there were 232,000 new diagnoses of breast cancer the same year, with 40,000 deaths — 17 percent.)
Doctors treat most early prostate cancers in one of three ways: surgical removal of the gland (radical prostatectomy), radiation from an external source (external beam) or insertion of a radioactive pellet (seed implantation). All three methods are about equally effective. When researchers at M.D. Anderson Cancer Center reviewed outcomes for 2,991 consecutive men, they found that 1,034 had radical prostatectomy, 785 had external beam radiation and 950 had seed implantation (222 had a combination of external beam and seed). Five-year survival rates were 81 percent for radical prostatectomy, 81 percent for external beam, 83 percent for seeds and 77 percent for combined therapy.
Risk factors for ED after treatment
Who develops ED after treatment? It depends on luck, the tumor's location in the prostate, the aggressiveness of its cells and two main risk factors:
Age. Whether you have prostate cancer or not, ED risk increases with age. The same goes for men with the cancer — that is, as your age at treatment increases, so does your risk of ED.
Treatment type. Surgery causes somewhat more ED than radiation. National Cancer Institute researchers followed 1,187 men for five years — 901 had surgery, 286 radiation. Sexual function declined in both groups, but was more pronounced after surgery. Twenty-one percent were potent after surgery, 36 percent after radiation. Other studies generally agree that prostatectomy causes somewhat more erection impairment than radiation.
Prostatectomy-related ED develops immediately, but some men recover some function over time. After radiation, fewer men report sudden ED; over time, however, it becomes more common.