According to a French reference cohort (VICAN), the results reported by patients 5 years from diagnosis remain, for some of them, marked in terms of continence and sexuality - which fully justifies active management of these aspects, and not only of the disease itself.
1. Urinary continence: gradual recovery in the majority of cases
After a prostatectomy, transient urinary incontinence is common in the first weeks, while the tissues heal and the sphincter regains its effectiveness. The vast majority of patients become continent again within 3 to 6 months, with perineal rehabilitation clearly accelerating this recovery. Mild and persistent incontinence after surgery only concerns a minority of patients (5 to 10% depending on the series), total incontinence having become rare thanks to advances in surgical techniques.
Perineal rehabilitation, started early after the intervention, plays a demonstrated role in accelerating the return to continence: it deserves to be offered systematically, and practiced diligently, rather than waiting for a spontaneous recovery.
2. Sexuality: frequent impacts, but solutions at each stage
The three main treatments (surgery, radiotherapy, hormonal therapy) can each affect sexual function, with different mechanisms and timings.
| Treatment | Typical impact on sexuality | Evolution |
|---|---|---|
| Surgery (prostatectomy) | Frequent erectile dysfunction, absent ejaculation (sperm removed) | Gradual recovery possible over approximately 2 years |
| Radiotherapy / brachytherapy | Progressive erectile dysfunction (tissue fibrosis) | Approximately 50% of erections kept remotely |
| Hormonotherapy | Marked drop in libido, for the duration of treatment | Reversible upon stopping treatment in the majority of cases |
It is important to note that the absence of sperm after prostatectomy (with the seminal vesicles and vas deferens removed or severed) is different from retrograde ejaculation, seen after benign hypertrophy surgery, where sperm flows back into the bladder—the two mechanisms are often confused by patients.
3. Solutions exist, at each stage and according to needs
Management of sexual disorders after treatment is based on several options, to be discussed with a urologist or a specialized sexologist:
- ●Oral vasodilator medications: variable effectiveness depending on the treatment received and the post-operative time.
- ●Intracavernous injections: often allow a satisfactory erection after a learning phase, including when oral treatments are no longer sufficient.
- ●Vacuum pump (vacuum): non-drug solution, effective in the majority of cases, without systemic side effects.
- ●Penile implant: surgical option considered as a last resort, after failure of previous approaches.
For men wishing to preserve the possibility of paternity, sperm conservation before treatment can be offered and should be discussed in advance with the healthcare team.
4. Don’t be alone when it comes to these topics
Sexuality after prostate cancer remains a subject largely under-addressed in consultation, even though its impact on quality of life and self-image is documented. A dedicated consultation, combining information and personalized support, significantly improves the experience of patients and their partners. There is no reason to consider these difficulties as inevitable: they are an integral part of the care process, just like the treatment of cancer itself.
⚠️ To remember from a medical point of view
Recovery of continence after prostatectomy most often extends over 3 to 6 months: this period is normal and should not be a source of excessive concern if it is respected.
Perineal rehabilitation, started early, significantly accelerates the return to continence: it deserves to be requested systematically after an intervention.
Sexual disorders after treatment do not always resolve spontaneously: a specialist consultation (urologist, sexologist) allows us to explore solutions adapted to each situation, rather than suffering them in silence.
Tips to remember:
- ●The vast majority of patients regain normal continence within 3 to 6 months following a prostatectomy, particularly with early perineal rehabilitation.
- ●The absence of sperm after prostatectomy is not the same thing as retrograde ejaculation observed after BPH surgery — two mechanisms often confused.
- ●Around half of men maintain satisfactory erections after radiotherapy, a figure to be weighed against other therapeutic options.
- ●Solutions exist at each stage of post-treatment sexual disorders: medications, injections, vacuum pump, or implant as a last resort.
- ●Sexuality after prostate cancer remains a subject that is rarely discussed in consultations: it is legitimate, and beneficial, to discuss it openly with your healthcare team or via the Iris Prévention health check-up.
