From OncoLog, October 2003, Vol. 48, No. 10

Sexual Function and Prostate Cancer:
The Importance of Realistic Expectations

by Leslie R. Schover, Ph.D.
Professor, Department of Behavioral Science

Many men choose a treatment for prostate cancer based on the unrealistic expectation that it will spare their sexual function. When they do end up with problems, the stigma of being a “treatment failure” adds yet another barrier to their seeking medical help.

New treatments that are designed to eradicate prostate cancer without compromising sexual function have been highlighted in the professional literature and the lay press, but they typically include only younger, healthier patients who are treated in academic medical centers. A consistently less positive picture comes from published findings in studies of unselected patients treated in community settings, especially when sexual function is assessed using detailed, validated questionnaires.

The marketing of sildenafil has encouraged more men to get treatment for erectile dysfunction, but it does not help many prostate cancer survivors. In our recent follow-up study of men treated for localized prostate cancer, only 16% of 549 men who tried sildenafil found that it greatly improved their sex lives, and 61% had stopped using it. More invasive treatments such as penile injections or a penile prosthesis had much higher success rates.

A narrow focus on erectile rigidity overlooks the role of the partner in successful sexual recovery after prostate cancer. In our survey, 66% of men noted that their partner had a problem that interfered with sex, most commonly a loss of desire. Not surprisingly, men whose partners enjoyed sex were themselves more satisfied.

What then can physicians do to prepare men to resume having sexual intercourse after prostate cancer treatment?

• Use realistic estimates of the percentage of men whose sexual function is spared after prostate cancer treatment.


• Emphasize that men who retain or regain normal erections are almost always younger than 65 (the younger, the better) and had normal erections before treatment.


• Encourage men to try phosphodiesterase-5 (PDE-5) inhibitors, but with the caveat that they work best for men who already have erections that are close to normal and more invasive options may be needed.


• Include the partner in counseling as much as possible. Assess her sexual function and give referrals when needed.


• If you do not have the time to educate patients about the sexual impact of treatment, delegate that task to one of your treatment team members.

At least half of all prostate cancer survivors are concerned about staying sexually active. They and their partners need your help and encouragement to get their sex lives back on track.

For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789.

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