The short answer
Erectile dysfunction is common after prostate cancer surgery, radiation and hormone therapy, and each cause behaves differently. Nerve healing after surgery is slow, radiation problems appear later, and erection pills often do not work during hormone therapy.
Nerve healing after prostate surgery can take up to 2 years, so little recovery at three months is expected.
After radiation, erection problems usually appear 6 months to 2 years later and may improve after 2 to 3 years.
Sildenafil usually does not work during hormone therapy, because it does not address the loss of sexual desire.
More men recover erections after nerve-sparing surgery than when sparing the nerves is not possible.
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The full explanation.
Erectile dysfunction means trouble getting or keeping an erection. After prostate cancer treatment it is common, expected, and treatable. Raising it in clinic is a standard part of prostate cancer follow-up. Your urologist has this conversation constantly.
Why Each Treatment Causes It
Surgery. The nerves that control erections sit right next to the rectum. They also wrap around the back and sides of the prostate gland. The American Cancer Society states that "most men who have these types of surgeries might have some trouble with erections." Outcomes are better where the surgeon is able to spare those nerves: "more men recover erections after nerve-sparing surgery than men who have surgery in which nerve sparing isn't possible." Nerve healing is slow. ACS says "this healing can take up to 2 years." Are you three months out with nothing working yet? That is within the expected range.
Radiation. Trouble with erections comes on more slowly with radiation than with surgery. ACS reports problems typically appearing between 6 months and 2 years after radiation ends. It also notes the problems "are not always permanent. They might get better after 2-3 years." NCI adds that pelvic radiation can damage blood vessels or nerves. That covers both external-beam radiation and brachytherapy (radiation given from sources placed inside the body). The result is difficulty getting or keeping an erection.
Hormone therapy (ADT). NCI lists two side effects of androgen deprivation therapy: "loss of interest in sex (lowered libido)" and "erectile dysfunction." One point from NCI's hormone therapy fact sheet is worth knowing before you spend money on pills. "Erectile dysfunction drugs such as sildenafil (Viagra) do not usually work for men undergoing hormone therapy because these drugs do not address the loss of libido (sexual desire) that is associated with a lack of androgens." On recovery, NCI says most sexual and emotional side effects "will eventually go away if a man stops taking hormone therapy." But for older men, and for those on ADT a long time, "testosterone levels may not fully recover and these side effects may not disappear completely."
Other factors. ACS notes that men under 60 tend to recover better. Erection quality before treatment matters too. So do diabetes, high blood pressure, heart disease, obesity, and smoking.
What Can Be Done
The NIH's National Institute of Diabetes and Digestive and Kidney Diseases lists the standard options. They are generally tried in this order.
Oral medicines. PDE5 inhibitors "improve blood flow to the penis" and "may help you get and keep an erection." Note the caveat above about hormone therapy.
Injections and urethral suppositories. These produce "a quick, automatic erection by increasing blood flow to the penis." The injection goes into the penis. The suppository is inserted into the urethra. Your health care professional "will teach you how to give yourself an injection or insert a suppository." You learn this in clinic.
Vacuum erection devices. These have three parts. A plastic tube goes around the penis. A pump creates a vacuum. An elastic ring holds the erection. Side effects can include coldness, numbness, purple discoloration, or bruising. These are usually painless, and they disappear in a few days.
Testosterone therapy. NIDDK describes this for men who have ED plus low testosterone. It is given as an oral medicine, a patch, or a gel, usually with a PDE5 inhibitor. But that page addresses ED generally, not men treated for prostate cancer. And hormone therapy for prostate cancer deliberately lowers testosterone. Ask your oncologist before assuming it applies to you.
Surgery. NIDDK covers implanting a prosthesis and repairing arteries. It notes that artery repair works best in younger men. NCI describes the implant as "a firm rod or inflatable device (penile implant)" that allows a man to have and keep an erection.
Counseling. NIDDK recommends counseling where mental health or emotional issues are involved. The aim is to lower anxiety and stress about sex.
Lifestyle. Quit smoking. Limit alcohol. Get more physical activity. Reach a healthy weight. Stop illicit drug use.
Where the Evidence Here Is Thin
These federal and cancer-organization pages leave several gaps. They do not give success rates for each option after prostate surgery or radiation. They do not name individual drugs with doses or timing. And they do not set out a "penile rehabilitation" protocol. Anyone quoting a precise percentage should be able to show you the study. Ask your urologist what the numbers look like for your case.
Other Changes You Might Notice
NCI notes that damage to the prostate from radiation can cause dry orgasm — orgasm without semen. Chemotherapy, hormone therapy, and some other medications may lower testosterone and sexual desire. Pain, fatigue, hair loss, depression, and sleep problems reduce interest in sex too. Treating those can matter as much as treating the erection.
Questions Worth Asking
NCI suggests these. What sexual problems are common among men receiving this treatment? When might these changes occur, how long might they last, and will any be permanent? How can they be prevented, treated, or managed? What specialists would you suggest I talk with?
When to get help sooner
- Call 911 or go to an emergency department if an erection will not go down after 4 hours. NIDDK calls this priapism, and it can happen with the oral medicines, the injections, or the urethral suppositories. Waiting it out risks lasting damage to the penis, so this is not a next-morning problem.
- Call 911 or go to an emergency department if sight or hearing drops away suddenly after an oral ED medicine. NIDDK names vision or hearing loss as a reason to get help right away.
- Call your care team within a day or two if a vacuum device leaves numbness, coldness, or bruising that has not faded in a few days. NIDDK expects those effects to be brief and painless.
Sources
- National Cancer Institute: Sexual Health Issues in Men and Cancer Treatment. https://www.cancer.gov/about-cancer/treatment/side-effects/sexuality-men
- National Cancer Institute: Hormone Therapy for Prostate Cancer Fact Sheet. https://www.cancer.gov/types/prostate/prostate-hormone-therapy-fact-sheet
- National Institute of Diabetes and Digestive and Kidney Diseases (NIH): Treatment of Erectile Dysfunction. https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment
- American Cancer Society: How Cancer Can Affect Erections. https://www.cancer.org/cancer/managing-cancer/side-effects/sexual-side-effects/erections-and-treatment.html
Words to know
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Common questions
How long does recovery take after surgery?
Nerve healing is slow. ACS says this healing can take up to 2 years, and that more men recover erections after nerve-sparing surgery than after surgery in which nerve sparing is not possible. If you are three months out with nothing working yet, that is within the expected range.
Why is radiation different from surgery?
Trouble with erections comes on more slowly after radiation. ACS reports problems typically appearing between 6 months and 2 years after radiation ends, and notes they are not always permanent and might get better after 2 to 3 years. NCI adds that pelvic radiation can damage blood vessels or nerves, which covers both external-beam radiation and brachytherapy.
Will erection pills work if I am on hormone therapy?
Often not. NCI states that erectile dysfunction drugs such as sildenafil do not usually work for men undergoing hormone therapy, because these drugs do not address the loss of libido associated with a lack of androgens. NCI says most sexual and emotional side effects eventually go away if a man stops hormone therapy, but for older men and those on it a long time, testosterone levels may not fully recover.
What options are there, and in what order?
NIDDK lists them, generally tried in this order: oral PDE5 inhibitors that improve blood flow to the penis; injections or urethral suppositories, which produce a quick, automatic erection and which you are taught to use in clinic; vacuum erection devices with a tube, a pump and an elastic ring; testosterone therapy in some situations; and surgery such as a penile implant. Counseling is recommended where mental health or emotional issues are involved.
What makes recovery more or less likely?
ACS notes that men under 60 tend to recover better, and that erection quality before treatment matters. Diabetes, high blood pressure, heart disease, obesity and smoking all play a part. The lifestyle steps listed are quitting smoking, limiting alcohol, more physical activity, reaching a healthy weight and stopping illicit drug use.
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Written by: Cancer ExplainedSources last checked: 2026-07-23 what this meansLast updated: 2026-08-13Next planned review: 2027-01-28
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How this page was created
Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes. We do not employ clinicians and do not intend to — our work is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and checked line by line against the sources listed on it. That confirms the sources support what the page says. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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