Most erectile dysfunction is vascular — blood flow that is not what it was. ED after prostate cancer treatment is frequently neurological: the nerves running alongside the prostate that carry arousal signals have been damaged or removed.
That distinction matters because PDE5 inhibitors work by amplifying a signal. If the signal itself is impaired, amplification helps less.
What Different Treatments Do
Radical prostatectomy
Erections are usually affected immediately after surgery, even where nerve-sparing techniques were used, because the nerves are bruised and take time to recover. Recovery, where it happens, is gradual — commonly over one to two years.
Radiotherapy
Effects tend to appear more gradually, over months to years after treatment, as tissue changes develop.
Hormone therapy
Androgen deprivation reduces testosterone, which affects libido as well as erectile function. This is a different problem from a mechanical or vascular one, and PDE5 inhibitors do not address low desire.
Penile Rehabilitation
Many urology teams recommend starting treatment early after surgery rather than waiting to see what recovers. The rationale is that regular erections maintain oxygenation of the tissue, and prolonged absence can lead to fibrosis and permanent structural change.
Approaches vary between centres and the evidence is genuinely debated, but common elements include a low daily dose of a PDE5 inhibitor, vacuum erection device use, or intracavernosal injections. The key point is that this is something to ask your urology team about before or shortly after treatment, not two years later.
NHS Access
ED after prostate cancer treatment falls within the circumstances where a wider range of ED treatments can be prescribed on the NHS, rather than being limited to generic sildenafil. This is worth knowing, because men in this situation sometimes end up paying privately for treatments they were entitled to.
Ask your urology team or GP directly what you are eligible for.
When Tablets Are Not Enough
Where nerve damage is significant, oral medication may not work adequately. Established options include:
- Vacuum erection devices — mechanical, no drug interactions, often used as part of rehabilitation
- Intracavernosal injections (alprostadil) — bypass the nerve pathway entirely and work in many men for whom tablets do not
- Intraurethral alprostadil
- Penile implants — for men in whom other approaches have failed, with high satisfaction rates in that group
None of these are failures. They are the next steps in a pathway, and they exist because this situation is common.
The Conversation That Often Does Not Happen
Sexual function after prostate cancer treatment is frequently under-discussed, partly because the cancer understandably dominates the consultation. It is legitimate to raise it — before treatment when options are being chosen, and afterwards when recovery is being managed.
Partners are affected too, and many specialist centres offer psychosexual support alongside the physical treatment. Asking for it is not an imposition on a busy service; it is part of what recovery means.
What Not to Do
Do not treat this through a general online ED service that knows nothing about your surgery, your hormone therapy or your follow-up. This is one of the clearer cases where the assessment is the valuable part, and where the right treatment may not be a tablet at all.