After Prostate Cancer Treatment: A Urologist’s Honest Guide to Side Effects

You’ve Crossed the Finish Line. Now What?

You did it. You got through the diagnosis and the treatment, whether it was surgery or radiation. You’ve fought the big fight against prostate cancer. And now, you’re standing on the other side. But it feels… different. Your body doesn’t work quite the way it used to. This is the moment where the real recovery begins, and it’s the conversation we need to have, honestly and without fear.

The treatments that save your life are powerful. They have to be. And because the prostate is located in such a tight, critical space, that power inevitably causes some collateral damage. Think of it like a major renovation in a small apartment. You can’t take out a wall without creating some dust and disrupting the rooms next door. Our job, together, is now the cleanup and restoration project.

The Plumbing Issues: Let’s Talk About Leaks

After a prostatectomy, your internal plumbing is permanently changed. The prostate, which acted as a sort of secondary valve, is gone. Your bladder sphincter muscle has to learn to do the entire job of holding back urine by itself.

Here’s the blunt truth: you are going to leak. At first, it might be a lot. You’ll wear pads. You’ll feel frustrated. This is normal. This is expected. It’s not a sign that the surgery failed. It’s a sign that your body is healing and needs to be retrained. Kegel exercises are your new best friend. They are the physical therapy that strengthens that muscle. For the vast majority of men, with time and effort, this gets dramatically better.

The Intimacy Issues: Let’s Talk About Sex

This is the elephant in the room. Your erections will be different. The nerves responsible for erections are like two microscopic threads draped over the prostate. We do everything humanly possible to spare them, but they almost always get bruised and go into a deep sleep during treatment.

Waking them up is a slow, patient process. It can take a year, two years, sometimes longer. This is where penile rehabilitation comes in. It’s an active process. We use tools like pills, vacuum pumps, and sometimes injections to get blood flowing into the penis, keeping the tissue healthy and oxygenated while we wait for the nerves to recover. I have a whole guide on ED after prostate cancer treatment that walks you through these options. It is not a passive waiting game. It’s an active recovery plan.

The Bowel Changes After Radiation

If your treatment was radiation, the main neighbor that gets irritated is the rectum, which sits right behind the prostate. The radiation beams are incredibly precise now, but some energy still scatters to the rectal wall.

What does this feel like? You might experience diarrhea, a sense of urgency (having to rush to the bathroom), or even some rectal bleeding. Like the urinary issues, these symptoms are usually worst during and right after treatment, and they tend to calm down over the following months as the tissue heals. We can manage these symptoms with diet changes and medications.

The Most Important Thing I Can Tell You

Your journey didn’t end when your treatment did. In many ways, a new one began. You will have good days and bad days. You will feel moments of triumph and moments of deep frustration. All of this is part of the process.

Do not suffer in silence. Talk to your partner. Talk to your friends. And most importantly, talk to your medical team. There is not a single side effect you’re experiencing that we haven’t seen and managed a thousand times before. From medications for bladder control to the full range of options for erectile dysfunction, we have a plan for you.

You have been through a battle. Give yourself grace. Give your body time. And know that we are here to walk this next part of the road with you, every step of the way.