A life-saving treatment carries a hidden cost for thousands of men.
Prostate cancer touches millions of lives globally. As the second most common cancer in men worldwide, it will affect approximately 1 in 8 men during their lifetime 1 . Thanks to remarkable advances in detection and treatment, survival rates have soared—nearly 80% of men diagnosed today are expected to survive at least 10 years 2 .
Men affected by prostate cancer during their lifetime
10-year survival rate for men diagnosed today
Men experiencing ED after certain treatments
Yet, behind these encouraging statistics lies a challenging reality that often remains unspoken: the profound impact of treatment on sexual function. Erectile dysfunction (ED) represents one of the most common and distressing side effects of prostate cancer therapy, affecting up to 85% of men after certain treatments 3 . This article explores not just the science behind this connection, but also the very personal journeys of men navigating life after prostate cancer treatment.
To understand why erectile dysfunction occurs after prostate cancer treatment, we need to consider the delicate anatomy involved. The prostate gland sits nestled between the bladder and the penis, in close proximity to the intricate network of nerves and blood vessels essential for achieving and maintaining an erection 2 4 .
During surgical removal of the prostate, surgeons must carefully navigate around the cavernous nerves that run alongside the prostate. These nerves are responsible for triggering the release of nitric oxide, the key chemical that relaxes penile tissue and allows blood to flow in for an erection 3 .
This treatment reduces testosterone levels to slow cancer growth, but since testosterone plays a crucial role in sexual desire and function, its reduction directly impacts erectile capability 4 .
ED typically appears quickly, with a median time to diagnosis of 133 days.
ED develops more gradually, with a median time to diagnosis of 346 days 5 .
The challenge facing prostate cancer surgeons is formidable: remove all cancerous tissue while preserving the delicate nerves responsible for erectile function. For years, surgeons have relied on nerve-sparing techniques, but the fear of leaving cancer behind often led to overly conservative approaches.
In 2025, a landmark clinical trial introduced a more precise solution—the NeuroSAFE technique—and became the first randomized, controlled trial to rigorously evaluate its impact on preserving erectile function 7 .
The NeuroSAFE PROOF trial, led by researchers from UCL and UCLH, followed 344 men diagnosed with prostate cancer who were scheduled for prostate removal and had no prior erectile issues 7 . The trial design was straightforward yet powerful:
In the NeuroSAFE group, after the prostate was removed while preserving the maximum amount of nerve tissue, the organ was immediately flash-frozen.
If cancer was detected at the edges, the surgeon could immediately remove additional tissue, sacrificing the nerves but ensuring complete cancer removal.
The results, published in The Lancet Oncology, demonstrated substantial benefits for patients undergoing the NeuroSAFE procedure 7 . The table below summarizes the key findings from the trial:
| Outcome Measure | NeuroSAFE Group | Standard Surgery Group | Improvement |
|---|---|---|---|
| Men with no or mild ED | 39% | 23% | 70% relative increase |
| Men with severe ED | 38% | 56% | 32% relative reduction |
| Recovery of urinary control | Faster recovery time | Slower recovery | Significant timing difference |
"Our results show that, by using NeuroSAFE, nearly twice as many men don't have to face potentially life-changing loss of erectile function after prostate surgery" - Professor Greg Shaw, trial lead 7 .
The impact of erectile dysfunction extends far beyond physical function, striking at the core of masculine identity and emotional well-being. A comprehensive review of 52 studies revealed that masculinity—"men's identity or sense of themselves as being a man"—fundamentally shapes how men respond to ED after prostate cancer treatment 8 .
Researchers discovered that men employ various strategies to adapt to their changed sexual function:
Despite high overall relationship satisfaction, sexual relationship satisfaction scores were significantly lower 9 .
Fortunately, numerous treatments exist to help manage ED after prostate cancer treatment. The approach typically follows a stepped model, though recent guidelines have moved away from requiring patients to try conservative treatments before considering more advanced options 5 .
(e.g., sildenafil, tadalafil)
Mechanism: Increases availability of nitric oxide to promote erections
Effectiveness: Only 12-17% effective in first 6 months after surgery; improves as nerves heal
Considerations: First-line treatment; requires functional nerves
Early effectiveness: 15%Mechanism: Direct medication injection causes blood vessel relaxation and erection
Effectiveness: 52-67% recovery with consistent use in rehabilitation programs
Considerations: Cornerstone of penile rehabilitation; high effectiveness
Effectiveness with rehabilitation: 60%Mechanism: Creates vacuum to pull blood into penis; ring maintains erection
Effectiveness: Minimal research on effectiveness for rehabilitation
Considerations: Non-invasive option; can be used with other treatments
Mechanism: Surgical placement of inflatable prosthetic device
Effectiveness: >90% patient satisfaction; significant function improvement
Considerations: Considered when other treatments fail; high satisfaction
Patient satisfaction: 90%A critical concept in managing post-prostatectomy ED is penile rehabilitation—a structured program aimed at preserving penile health during nerve recovery. The theory stems from understanding that natural erections deliver oxygen-rich blood to penile tissue, keeping it healthy 3 . Without these erections during the 18-24 month nerve recovery period, the tissue can atrophy, leading to permanent damage 3 .
Rehabilitation programs typically involve using penile injections or other treatments to achieve erections 2-3 times per week, regardless of sexual activity. This proactive approach has shown impressive results, with 52-67% of men who adhere to rehabilitation recovering erections, compared to only 20% of those who don't pursue rehabilitation 3 .
Despite these effective options, research reveals significant underutilization of ED treatments. One study of over 31,000 patients found that only 3.6% of prostatectomy patients and 1.4% of radiation patients eventually received penile implants 5 , despite their high satisfaction rates.
The landscape of prostate cancer treatment continues to evolve with a growing emphasis on preserving quality of life. Several recent advances show significant promise:
The ERECT trial demonstrated that MRI-guided radiotherapy could cut the risk of ED by more than half compared to conventional techniques 2 .
For men with low-risk, localized prostate cancer, active surveillance has emerged as an effective strategy that significantly reduces ED incidence 4 .
Research continues on innovative solutions including stem cell therapy, platelet-rich plasma injections, gene therapy, and tissue engineering 4 .
| Management Approach | ED Incidence | Key Advantages | Considerations |
|---|---|---|---|
| Active Surveillance | 30-52% maintain function at 6 years | Avoids treatment side effects; preserves quality of life | Requires regular monitoring; not suitable for all cancer types |
| NeuroSAFE Surgery | 39% with no/mild ED at 12 months | Maximizes nerve preservation without compromising cancer control | Requires surgical expertise; not appropriate for all patients |
| MRI-Guided Radiation | 16% with ED at 18 months | Non-invasive; precisely targets radiation | Availability limited to specialized centers |
| Standard Surgery | 23% with no/mild ED at 12 months | Established technique; widely available | Higher ED rates compared to advanced techniques |
The journey through prostate cancer treatment represents more than a medical challenge—it's a deeply human experience that extends far beyond survival statistics. As one research participant aptly expressed, "It's not just about living; it's about living well after cancer" 9 .
The good news is that the medical field is increasingly recognizing the importance of preserving both life and quality of life. Technological innovations like the NeuroSAFE technique and MRI-guided radiotherapy, combined with more honest conversations about sexual health, are creating new possibilities for men facing prostate cancer.
While erectile dysfunction remains a significant concern after treatment, the evolving landscape offers genuine hope. Through continued research, comprehensive patient education, and a holistic approach to care that addresses both physical and emotional needs, we can ensure that prostate cancer survival comes with the prospect of not just longer life, but better life.