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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