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Originally published November 6, 2025
Last updated November 6, 2025
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Getting a prostate cancer diagnosis can be deeply troubling. “There’s a significant psychological impact of a cancer diagnosis,” says Kian Asanad, MD, director of the USC Fertility and Men’s Sexual Health Center, part of USC Urology and Keck Medicine of USC. The psychological impact can directly affect men’s sexual health — but so can the treatments for prostate cancer.
Dr. Asanad discusses the sexual side effects of prostate cancer treatments and how best to address them. “The good news is we have so many options for these issues,” he says.
The main type of surgery for prostate cancer, radical prostatectomy, removes the prostate gland and some of the tissue around it. Because it can also affect the nerves crucial for erections, this procedure can significantly decrease erectile quality.
Also after surgery, some men might experience urinary incontinence, or leaking urine. Most men regain urinary continence within three to six months following surgery, Dr. Asanad says. “But you can imagine that if your erectile quality has recovered and is quite strong, but you are leaking urine, that plays a big role during intimacy.”
After radiation therapy for prostate cancer, some men might experience strong urges to urinate frequently or to have a bowel movement. Radiation can have other effects such as creating scar tissue within the urethra or bladder neck. More rarely, patients might develop radiation-induced fistulas or blood in the urine.
And all of these conditions can impact sexual health.
For erectile dysfunction, “we have a ton of different treatment options,” Dr. Asanad says.
Both before and after surgery, he typically gives patients a low daily dose of tadalafil or a similar medication. “This has been shown to significantly improve blood flow to the penis and erectile function after surgery,” he says.
If men need more of a boost to get an erection, Dr. Asanad might recommend self-administered penile injections or a vacuum pump placed over the penis.
Penile surgery is another option. Dr. Asanad can implant a penile prosthesis that induces erections mechanically. Men with this procedure report excellent satisfaction, he says.
But before treating erectile dysfunction, Dr. Asanad typically addresses any urinary incontinence first. Physical therapy before and after surgery can strengthen the pelvic floor. “That’s really the best treatment approach for the majority of patients,” he says.
For men who continue to leak urine, surgical options — including artificial urinary sphincters, adjustable continence therapy balloons and male slings — work very well.
Libido is very complex, Dr. Asanad explains. Depression and anxiety following a prostate cancer diagnosis can lead to low libido. For men with these symptoms, he recommends mental and sexual health therapists and possibly medication.
For men who have severely low libido several months after treatment, Dr. Asanad checks to ensure their testosterone levels are optimal, since low testosterone is a major cause of diminished libido.
Prostate cancer surgery removes the prostate and seminal vesicles, so there’s no fluid to transport the sperm. The procedure also removes the ejaculate tube, so there’s no pathway for the sperm. As a result, men become infertile after prostate cancer surgery.
Radiation treatment also has fertility implications: Radiation of the prostate, or scattered radiation of the testicles, can significantly decrease semen production and impact sperm production.
Fertility isn’t a concern for many men diagnosed with prostate cancer, Dr. Asanad says, since they’re mostly over 65 years old and not aiming to achieve a pregnancy. But for men in their 40s and 50s or even older men looking to achieve a pregnancy, Dr. Asanad typically recommends freezing sperm prior to surgery.
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