Prostate Cancer, PSA Testing and the Impact on Sex and Intimacy

Written By Nia Jane

A diagnosis of prostate problems can bring understandable concerns about health, treatment decisions and the future. For many people, however, a common question is:

"What will this mean for my sex life and my relationship?"

Unfortunately, conversations about sexuality and intimacy are often overlooked by healthcare professionals within routine care, despite being central to a person’s quality of life.

Understanding what the PSA test can and cannot tell us - and knowing what to expect from different treatment pathways - can help individuals and couples feel more informed and prepared.

What is the Prostate?

The prostate is a small gland located below the bladder and in front of the rectum. It surrounds part of the urethra and produces some of the fluid (“seminal fluid”) that makes up semen.

Changes to the prostate become more common with age and can include:

  • Enlargement of the prostate (benign prostatic hyperplasia)

  • Inflammation or infection (prostatitis)

  • Prostate cancer

Importantly, symptoms do not always indicate cancer, and prostate cancer itself may cause no symptoms at all in its early stages.

What Is a PSA Test?

PSA stands for prostate-specific antigen, a protein that is produced by both healthy and abnormal prostate cells.

A PSA test is a simple blood test that measures the amount of PSA that is circulating in the bloodstream. Although higher levels can sometimes be indicative of prostate cancer, PSA levels might also rise for many other reasons.

These include:

  • An enlarged prostate

  • Prostatitis or urinary infections

  • Recent ejaculation

  • Anal sex or stimulation of the prostate

  • Vigorous exercise, particularly cycling

  • Recent urological procedures or biopsies

For this reason, PSA is a useful tool, but it should not be considered a definitive test for prostate cancer.

In other words - a raised PSA does not necessarily mean cancer is present, and a normal PSA does not completely rule it out.

Who Should Consider PSA Testing?

There is currently no national screening programme for prostate cancer in the UK.

However, the UK National Screening Committee has recently recommended a PSA test every two years for a specific population of high-risk men - those

  • aged 45-61

who have both:

  • a confirmed BRCA2 pathogenic gene variant, and

  • a family history of breast, ovarian, pancreatic or prostate cancer.

This is currently being rolled out in England, while the devolved nations Scotland, Wales and Northern Ireland will review the implementation.

Men over 50 can also request an ‘informed choice’ PSA test after discussing the potential benefits and limitations with their GP. Shared decision-making is important as PSA testing could also identify slow-growing cancers which may never have caused any harm - potentially leading to unnecessary treatment and side effects.

How Can Prostate Cancer Affect Sexual Function?

Sexual changes can occur because of the cancer itself, but more commonly arise as a result of its treatment.

The effects vary considerably depending on:

  • Age

  • Baseline sexual function

  • Other health conditions

  • Type of treatment received

  • Whether nerve-sparing surgery is possible

  • Individual and relationship factors

Common changes can include:

  • Difficulty getting or maintaining erections

  • Reduced libido

  • Changes in orgasm intensity or sensation

  • Dry orgasm (orgasm without ejaculation, or with retrograde ejaculation)

  • Changes in penile length or shape

  • Reduced fertility

  • Urinary leakage during sexual activity

  • Fatigue and altered body image

How Different Treatment Options May Affect Intimacy

Active Surveillance

Not everyone with prostate cancer requires immediate treatment.

For some people with low-risk or slow-growing cancers, active surveillance involves regular PSA tests, scans and monitoring, rather than immediate or aggressive intervention.

Sexual function may remain broadly unchanged, however anxiety and uncertainty can still affect desire and intimacy.

Surgery (Radical Prostatectomy)

Surgery to remove the prostate can also affect the nerves and blood vessels involved in erections.

Even with nerve-sparing procedures, temporary erectile difficulties are common, and recovery can take months or years. Some people experience longer-term changes. Dry orgasms are expected after prostate removal because semen is no longer produced.

Radiotherapy

Radiotherapy may have less immediate impact on erections than surgery, however erectile difficulties can still develop gradually over time as blood vessels and nerves are affected.

Hormone Therapy

Hormone therapy lowers testosterone levels in order to slow cancer growth.

Common sexual side effects can include:

  • Reduced libido

  • Fewer spontaneous erections

  • Changes in body composition

  • Fatigue

  • Mood changes and reduced confidence

Intimacy Is More Than Erections

One of the most difficult aspects of prostate cancer treatment can be the loss of a familiar sexual script.

Many people understandably equate sex with penetrative intercourse and erections. When things change, it can feel as though intimacy itself has been lost.

However - sexuality is broader than erection quality or ejaculation.

In a wider context, intimacy may also include:

  • Touch and physical affection

  • Mutual pleasure

  • Oral sex

  • Manual stimulation

  • Sensate focus exercises

  • Shared erotic exploration

  • Emotional closeness and vulnerability

Many couples find that redefining intimacy allows them to build a sexual relationship that remains fulfilling, even when bodies function differently to the way they did before treatment.

The Emotional Impact on Relationships

Prostate cancer affects both the individual and their partner.

Common emotional responses can include:

  • Grief for previous sexual functioning

  • Anxiety about attractiveness or masculinity

  • Fear of disappointing a partner

  • Avoidance of intimacy due to performance concerns

  • Feelings of rejection or misunderstanding within the relationship

These reactions are understandable, however many couples unfortunately tend to stop talking about sex at precisely the time they need strong and clear communication the most.

Open, honest conversations about fears, expectations and changing needs can reduce misunderstanding and strengthen relational connection during treatment and recovery.

Support Is Available

Sexual changes after prostate cancer are common, but they are not something people simply have to "put up with."

Support options may include:

  • Erectile dysfunction medication

  • Vacuum erection devices

  • Penile injections

  • Pelvic health physiotherapy

  • Penile rehabilitation programmes

  • Psychosexual therapy

  • Couples therapy

  • Peer support groups

Seeking support early often leads to better outcomes.

Final Thoughts

Prostate cancer treatment can change how sex looks and feels, but it does not automatically mean the end of intimacy, pleasure or connection.

Understanding the role and limitations of PSA testing, being informed about treatment options, and recognising that sexuality extends beyond erections can help individuals and couples navigate these changes with greater confidence and compassion.

If you or your partner are experiencing difficulties following prostate cancer treatment, specialist psychosexual support can provide a space to explore these changes, improve communication and develop new ways of experiencing intimacy.

For further information, visit NHS Prostate Cancer Information or Prostate Cancer UK.

Nia Jane
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