Prostate cancer treatment: side effects and impacts

Prostate cancer treatment: side effects and impacts

  November 11, 2026    Stephen Cobb

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In this, the ninth article in my 30-article series to raise money for prostate cancer research during November, 2026, I look at things you need to think about if doctors recommend "radical treatment" for your prostate cancer.

[Note: I pledged to produce these articles, even though I am currently undergoing prostate cancer treatment, for a fundraising pledge which you can donate to here. Please consider doing so and sharing a link to this blog (CobbsBlog.com) on social media.]

As I discussed in a previous article, "radical treatment" for prostate cancer means taking drastic action to get rid of the cancer cells. There are two main courses of actions and both come with serious side effects. On the one hand there is surgery to remove the prostate. On the other hand there is RT+ADT, which involves leaving the prostate in place and killing the cancer cells by targeting them with X-rays (radiotherapy or RT), while at the same time depriving them of the testosterone on which they thrive by ingesting chemicals (known as Androgen Deprivation Therapy or ADT). 

Surgery side effects

The main side effects of surgery involve urinary control and sexual function. Many men experience urinary incontinence following surgery and this may mean wearing a catheter for a while, although the incontinence often diminishes over time.

Erectile dysfunction is also common because the nerves responsible for erections run alongside the prostate and can be damaged during its removal. If the cancer is caught soon enough and is confined to certain parts of the prostate, there is a form of prostate surgery called nerve-sparing that can try to avoid nerve damage. Regrettably my cancer was not caught in time for the nerve-sparing option to be available; however, even nerve-sparing surgery cannot guarantee that erectile function will recover. 

Furthermore, removing the prostate and seminal vesicles means that ejaculation of semen becomes permanently impossible. Men can still experience orgasms, but these are dry orgasms, which may feel different or less satisfying. 

Surgery also eliminates the ability to father children through sexual intercourse. For younger men this may be a major concern, but sperm banking (cryopreservation) is an option: you provide a semen sample at a specialized fertility clinic or hospital before your surgery takes place. The sample is frozen in liquid nitrogen and can be stored for years

All in all, prostate surgery comes with some pretty drastic effects that need to be processed. For some men these consequences may be manageable; for others they may represent a profound change in their sexual identity, relationships and sense of wellbeing. Age, culture, and personal circumstances will all play a part in the processing.

RT+ADT side effects

The side effects of RTHA come from two directions. Radiotherapy can irritate or damage nearby tissues, causing urinary urgency, frequent urination, bowel disturbances, rectal bleeding and, sometimes, long-term erectile dysfunction. 

Hormone therapy (ADT) adds a second and potentially more widespread set of problems. Suppressing testosterone can dramatically reduce sexual desire and erectile function, while also producing fatigue, hot flushes, disturbed sleep, loss of muscle mass, weight gain, mood changes and difficulties with concentration or motivation. 

Longer-term treatment with ADT can weaken bones, alter cholesterol levels, increase insulin resistance and raise the risk of diabetes and cardiovascular disease. Some effects improve after hormone treatment stops, but recovery can take months or even years, and some changes may persist. 

As someone who chose RT+ADT over surgery, I will be documenting how things go at the end of my hormone treatment. I take my last Relugolix pill on the morning of March 31, 2026. The immediate post-ADT phase comes with its own stress factors because the extent to which the radiotherapy eradicated your cancer cells cannot be determined until you stop suppressing your testosterone.

The future of prostate cancer treatment 

The current irony of prostate cancer treatment is that something intended to prolong your life can simultaneously make that life considerably more difficult to enjoy. I firmly believe that this will change over time. Later this month I will be talking about promising new directions in prostate cancer treatment, like the one I described here.

In the meantime, donating to prostate cancer research programs makes sense to me, as does lobbying your government, spreading the word, and taking part in research projects. I hope to highlight some of those in a future article as well as describe one in which I participated.

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The two main prostate cancer treatment paths

The two main prostate cancer treatment paths

  November 10, 2026    Stephen Cobb

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The eighth article in my 30-article series to raise money for prostate cancer research during November, 2026, describes what happens during the two main "radical treatment" options for prostate cancer.

(Note: I pledged to produce these articles, even though I am currently undergoing prostate cancer treatment, for a fundraising pledge which you can donate to here. Please consider doing so and sharing a link to this blog (CobbsBlog.com) on social media.)

Prostate Removal Surgery or Radiotherapy + Hormone-Ablation Therapy 

These are the two main pathways for treating prostate cancer, particularly when the cancer has not spread beyond the prostate itself. For brevity I am calling these options Surgery and RT+ADT for Radiotherapy and Androgen Deprivation Therapy (ADT) because ADT is the most common form of Hormone-Ablation therapy (it's those testosterone-crushing chemicals that I have described elsewhere).

Notice that the heading says surgery OR radiotherapy, not surgery VS. radiotherapy. As I described here, the probability of success is about equal for both pathways. Choosing between them begins with understanding them and their respective side effects and implications, addressed in this article. In my own experience I found that my urologists did not try to influence my decision one way or the other, which I appreciated.

Surgery

Surgery involves removing the prostate (radical prostatectomy). The entire prostate gland is taken out, usually along with the seminal vesicles (their job ito produce much of the fluid in semen). The goal of surgery is straightforward: remove the cancer before it spreads elsewhere. Modern procedures often use robotic assistance, allowing surgeons to operate with great precision. 

However, the prostate sits in a crowded and sensitive part of the male anatomy, to say the least. It is surrounded by nerves, blood vessels and structures essential to urination and sexual function. Removing it without disturbing these structures is difficult, even for highly skilled surgeons. 

While surgery can be very effective against cancer that has not spread, it can also produce lasting changes to the patient's body and quality of life. (I cover this in the blog post "Prostate cancer treatment: side effects and impacts.")

RT+ADT

Radiotherapy combined with androgen deprivation therapy (RT+ADT) takes a very different approach from surgery. Instead of removing the prostate, high-energy photon beams are precisely aimed at the gland to damage the DNA of cancer cells, preventing them from reproducing. 

For men with sufficiently significant disease, radiotherapy is often combined with androgen deprivation therapy (ADT), drugs that dramatically reduce the body's production of testosterone or block its effects. This is because testosterone encourages most prostate cancers to grow, so depriving the cancer of this hormone makes treatment more effective. 

However, as I quickly learned when I started taking ADT tablets, testosterone is not simply a hormone that makes men interested in sex. It plays an important role in physical strength, metabolism, bone health and mental wellbeing. Removing testosterone from your body will have consequences throughout the body. (I cover this in the blog post "Prostate cancer treatment: side effects and impacts.")

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Go South Cobb! Marching band chosen for Obama parade

Go South Cobb! Marching band chosen for Obama parade

  December 17, 2008    Stephen Cobb

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About ten days ago my wife pointed out this article in the Atlanta Journal Constitution about a high school band selected to march in Mr. Obama's inauguration (technically he is Mr. Obama between being Senator Obama and President Obama). She had noticed the article simply because of my last name, Cobb.

Now I  was already aware that Cobb County was named after an indirect ancestor of mine (that branch of the tree split off many generations ago). But I was not familiar with South Cobb High School. Apparently the students and staff of the school have worked really hard to turn the band around in the last five years and make it something really special.

Getting to march down Pennsylvania Avenue for the inauguration of the first black president of the United States is a huge deal and the school's excitement was matched only by their concern that this honor is truly honorary, there are no funds attached. So I emailed the principal and asked where people should send donations. He sent me a very nice reply:

"Your email address [@scobb.net] made me smile...I've attached the donation letter and encourage you to contribute or share with other Cobbs as you feel appropriate :-)

Thanks for your interest in our students. If you have not done so already, I encourage you to check out www.cbs46.com and click on the video portion of your story. It will put a face with the other Cobb name...hope we do your family proud!"

I'm sure they will, and I have posted the donation instructions here, so anyone who feels so inclined can lend their support to this great accomplishment. You can also donate online here. A formal donation request letter from the school is here. We'll definitely be watching for these kids on inauguration day.

Go Blue Eagles!

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