Because the prostate is close to several vital structures, prostate cancer surgery can disrupt normal urinary, bowel, and sexual functioning.
During a prostatectomy, the bladder is pulled downward and connected to the urethra at the point where the prostate once sat. If the sphincter at the base of the bladder is damaged during this process, some degree of urinary incontinence or leakage may occur. Nearly all men will have some form of leakage immediately after the surgery, but this will improve over time and with strengthening exercises. Most men regain urinary control within a year; approximately 1 in 5 men will have mild leakage requiring the use of 1 or more pads per day long-term. Pelvic floor muscle training with a physical therapist can help. In the case where side effects are severe, an artificial urinary sphincter can be considered.
Regardless of whether the nerves were spared during surgery, erectile dysfunction remains the most common side effect after treatment. This is because the nerves and blood vessels that control the physical aspect of an erection are incredibly delicate, and any trauma to the area can result in changes. Modern studies have shown that overall, about 40% of men lose some erectile function after surgery. However, within 1-2 years after treatment, most men with intact nerves will see a substantial improvement. The skill of your surgeon or physician can have a significant impact on this outcome, so it’s important to select your team carefully. Likewise, men with baseline erectile dysfunction and/or other diseases or disorders that impair their ability to maintain an erection, such as diabetes or vascular problems, will have a more difficult time returning to pre-treatment function. It’s important to remember that your functionality after treatment can only be as good as it was before treatment. The best predictor of how you will be after treatment is how healthy you were going into treatment.
There are also definite fertility impacts from surgery.
It is very rare (less than 1%) for men to have altered bowel function after surgery. In rare cases of locally advanced prostate cancer where the cancer invades the rectum, surgery may result in rectal damage.