Erectile Dysfunction and Prostate Cancer: Treatment and Recovery

This page explains why prostate cancer treatment affects erections, what recovery looks like, and the options. It does not cover whether ED raises cancer risk. Your urologist or cancer team decides what fits you.

Why prostate cancer treatment affects erections

Erections depend on two small bundles of nerves. The American Cancer Society explains: "Erections are controlled by bundles of nerves that run along either side of the prostate." Any treatment aimed at the prostate can harm them, or the blood vessels nearby.

Surgery: radical prostatectomy

Radical prostatectomy means removing the whole prostate. MedlinePlus lists the risks of this surgery, including "Erection problems" (MedlinePlus: radical prostatectomy, read 14 November 2026).

Surgeons try to save the nerves when they can. The National Cancer Institute says: "In some cases, the nerves that control penile erection can be saved with nerve-sparing surgery. However, this may not be possible in men with large tumors or tumors that are very close to the nerves." (NCI: prostate cancer treatment, read 14 November 2026)

What happens next depends on the nerves. The American Cancer Society sets out three cases:

• If both nerve bundles are removed, "you won't be able to have spontaneous erections", though aids may still work.
• If one side is removed, erections are still possible, but less likely.
• If both are saved, "you might have normal erections at some point after surgery."

It adds that "the younger you are, the less likely you are to be seriously affected." Your age and how good your erections were before surgery both matter.

Radiation, freezing and other treatments

Surgery is not the only cause. The National Cancer Institute says: "Radiation therapy can cause impotence and urinary problems that may get worse with age." Impotence is an older word for ED.

The same NCI page says cryosurgery, which freezes the cancer cells, "can cause impotence and leakage of urine from the bladder or stool from the rectum" (NCI: prostate cancer treatment).

Hormone therapy and low desire

Hormone therapy lowers or blocks male hormones, which prostate cancer uses to grow. The NCI lists its effects: "Hot flashes, impaired sexual function, loss of desire for sex, and weakened bones may occur in men treated with hormone therapy." (NCI: prostate cancer treatment) So with hormone therapy, the problem may be desire as well as erections.

How long recovery takes

Recovery after surgery is slow. The American Cancer Society says that if erections come back, "it often returns slowly. In fact, it can take from a few months to 2 or more years." (American Cancer Society: prostate cancer surgery) Our guide on whether ED can be reversed covers which causes can improve.

Many doctors start treatment early. The same page says that "Many doctors feel that regaining potency is helped along by trying to get an erection as soon as possible once the body has had a chance to heal". It calls this "penile rehabilitation". It also says it is "not clear" whether pills work better taken daily or only as needed. That choice is your doctor's.

ED treatment options after prostate cancer

The American Cancer Society lists four main options:

1. ED pills (PDE5 inhibitors). These include sildenafil (Viagra), tadalafil (Cialis), vardenafil and avanafil. The ACS warns: "These drugs won't work if both nerves that control erections have been damaged or removed."
2. Alprostadil. A drug injected into the penis, or placed in its tip, that can cause an erection without the nerve signal.
3. Vacuum devices. A plastic tube and pump that draws blood into the penis, with a ring to hold it.
4. Penile implants. Placed by surgery, for men when other methods do not help.

The ACS also warns that nitrates, used for heart disease, "can cause problems if you are taking a PDE5 inhibitor". Our ED pill side effects guide covers that rule from the labels.

What ED pills cost

Generic sildenafil and tadalafil are cheap with a prescription. Generic tadalafil starts at $1.80 a dose at Rex MD, and generic sildenafil at $1.60 a dose at Strut Health, visit included, checked November 14, 2026. With your own prescription, Cost Plus Drugs lists generic tadalafil 5 mg tablets at $0.20 each, before shipping. Our daily tadalafil cost guide compares daily and as-needed plans.

You can also get your pills through your own urologist instead of an online program. That keeps one team in charge of both the cancer and the ED.

Insurance and the diagnosis code

The diagnosis code can matter here. ED after prostate removal has its own ICD-10 code, N52.31, "Erectile dysfunction following radical prostatectomy" (NLM Clinical Tables: ICD-10-CM N52, read 14 November 2026). Aetna's ED policy, for example, lists "N52.31 - N52.39" among codes covered "if selection criteria are met" for its medical ED treatments (Aetna clinical policy bulletin 0007, read 14 November 2026). Medicare Part D still cannot cover drugs used for ED. Our guide to the ED ICD-10 codes explains what insurers ask for.

Every ED price is on ED cost by program, and the ranking is on our best ED programs.