Radiation with or without ADT? - Prostate Cancer N...

Prostate Cancer Network

2,933 members1,656 posts

Radiation with or without ADT?


I'm interested in avoiding impotence without taking on undue risk. Right now I've had both high dose radiation alone and radiation with ADT suggested by oncologists.

I was diagnosed in October 2019, Gleason 3+4, intermediate favorable. The cancer is right at the capsule and at the neuro-vascular bundle.

I'm trying to get better understanding of what results have been for others with and without ADT and the quality of life with ADT.

31 Replies

Evidence is that for favorable intermediate risk PC, adjuvant ADT does not improve results.

However, potency is no more at risk from the adjuvant ADT than it is without it. ADT affects libido, not potency.

From what I understand ADT does encourage or cause ED, that sexual satisfaction after radiation with ADT is lower than with radiation alone.

I was trying to figure out the mechanism for this to decide whether it is something that can be "toughed through". I just found and article that has a partial answer.

One cause of ED is that fibrous material replaces or crowds the smooth muscles that handle engorgement. Frequent erections supply fresh oxygen to the muscles tend to keep things healthy.

My fear with ADT was that the 3 to 6 month lack of erection and, therefore, oxygenation would lead to development of fibrous tissue and degraded erections. If it is just a matter of needing to have erections during treatment then my question is whether it is possible to become aroused by stimulation and ensure oxygenation during ADT despite the lack of libido.

For this reason I am curious about the experiences of others.

However, I just ran into an article that explains that androgens keep the smooth muscle healthy and ADT shuts down testicular androgen production at the least. Not sure about other sources. The authors did not go into detail as to whether oxygenation less androgens make a difference.

On the other hand, radiation treatment encourages ED by accelerating aging of the vascular system that supplies blood to the nerves that cause erection. Apparently ED may not show up for 2 or more years, depending on the individual's health.

I had 18 months of ADT, with 13 of those post-RT. Yes, ADT lulls the libido to sleep, because T is dropped off a cliff, so that the melting down of sexual desire most often leads to stoppage of efforts to have erections. Under-oxygenation causes penile tissue damage, as you are aware.

My solution to keeping reliable erections all through ADT, despite zero T, was to use a simple homemade device -- the Loop -- that you make yourself with a simple cord.

Along with daily 5-mg tadalafil, erections were consistently achieved, which in turn reinforced libido with repeated erectile successes.

I am only now 6 wks out from the end of the last 3-month shot, and I still hardly have any T, so I still need to use the device much of the time to assist with sexual activity.

Message me if you want a free copy of instructions on making and using the Loop.

Good luck to you. This is a good group of guys who are all going through PC and its effects.

I owe you a reply. Yes, I did try the loop and cock rings. I didn't like the feel and then learned to produce erections with stimulation and erotica. Sex on lupron is interesting and we're having fun figuring out how it works. I and several others have found being passionate with their SO is the best way to get things going.

Your understanding about ADT is incorrect. There is a difference between having an erection and wanting to have an erection. I know several men who forced themselves to have erections despite lack of libido so that they wouldn't lose size or function in their apparatus.

I do understand the difference, but there is no information floating around as to whether an erection is possible despite the lack of libido. That is what I mean by "toughing it out"; mechanically going through the exercise despite the lack of desire.

Yes, it is possible - you just may lose interest in doing it.

Definitely possible. I did it successfully for 18 months of ADT. Just wasn't that urgent a feeling or drive to get the erection (forget worrying about the few-and-far-between-or-zero orgasms). I ignored that, and just made sure to create great erections with my device.

Libido was definitely preserved, i.e. kept awake, reinforced by repeated erectile successes.

IrishDude in reply to Tall_Allen

The injections work that way for me. At this point its hard to get excited, but I shoot up 2-3 times a week without fail. Most of the time I just fall asleep waiting for it to go down.

How long are you on ADT?

I am about 8 months into a 18 month sentence.

To both you and Handdrummer777, while on ADT are you able to feel physical stimulation that would cause an erection? I guess I'm asking whether the lack of libido kills feelings of arousal with stimulation.

Yes. I did not experience noticeable sensitivity loss, and orgasms were rare. Yet this ADT-demanded routine fit right into the headspace of edging, and getting into extending pleasure for its own sake. Once in awhile, a drygasm.

Hidden in reply to JuliesHusband

I had a foley for over a year . I ve had night wood each and every night ever since ..we are so much individual . No two exactly the same . My dr told me that adt on top of 8 weeks Rt was my nail in the coffin for any erections . he was wrong . Adt takes the desire and even the thought of sex away .plus I did an orchiectomy also . Erection is not sexual . It’s purely physical. I m happy if it keeps me healthy .. love for each other and the close affection towards each other is what counts. My wife is finishing menopause right now. We’ve made love once and that was years ago . She wed me with tubes and a foley . I was like that for 11/2 urs. But we have hope to re kindle . Most important is compassion for our partners side of it all . Good luck. Hold on to touching and affection .

WSOPeddie in reply to Tall_Allen

I disagree. No libido and no potency except with extraordinary means, like trimix or maybe vacuum pump.

Tall_Allen in reply to WSOPeddie

If you can get an erection with trimix, that means your lack of erections is not a loss of function.

Jp2sea in reply to Tall_Allen

Depends how you define function. If nerves are damaged, I don't think this is necessarily the case...


Trimix chemically enhances blood flow and may give you an erection but if it works I don't believe it means you can overcome ED.

After my RP, ADT and RT, I have ED. Trimix will work but causes pain. I'm happy to hear others have succeeded but I wouldn't assume it's possible for all. But I certainly don't regret. I was intermediate risk but it turned out to have left the prostate.

Tall_Allen in reply to Jp2sea

It means you don't have venous leak, so you can still get erections with aid.

IrishDude in reply to Jp2sea

My understanding is that there may be some other Trimix related mixtures (BiMix for one) that in many cases will reduce the pain. Your doctor should be able to help there.

In my case I had a lot of initial pain, but over time it has reduced. I am not sure if it is a result of getting used to it, but I have also been able to reduce the dosage over time and that is a likely factor as well.

Also just in case anyone is interested, I sat my last shot of Trimix out on the counter for two days before using it, and it worked fine. That may well not work for everyone as some people are more dependent on the part of the mixture that deteriorates without refrigeration. I am trying to get a feel for what I can get away with in case I ever get another sleepover opportunity. :)

Many have used the vacuum device to maintain erections during ADT. Using it several times a week for five - ten minutes will keep things functional until off ADT. I bought one from Walgreens on-line for $95 after a 15% first order discount.

My understanding is that the vacuum device draws in deoxygenated blood. I'll have to check further as I see it as part of penile rehabs at several major medical groups and if it is not bringing in oxygenated blood that would be puzzling.

Has anyone completed ADT who has made an effort to maintain penile health who can speak to actual results?

Has your husband already been treated? You might want to research HIFU as an option that promises to protect against incontinence and ED risks. It worked for me.


I was able to continue a reduced sex life while on Lupron. I undertook to stimulate my wife to the point where she became aroused and reached an orgasm and her arousal got me aroused. It required some discipline to do this since I had zero interest in sex at the start of each effort - but it always worked in the end.

As for erectile function - it was okay at the beginning but gradually reduced, presumably due to damage to the blood vessels needed for erections. By about five years after radiation the ability to get a usable erection was gone. Viagra no longer helped enough. From then on all sex was without erections, however it was no less satisfying because of that. I still liked it and still do like it, now 16 years after my radiation treatment at age 57.


Hidden in reply to AlanMeyer

Amazing AlanMeyer! Great spirit too. It’s wonderful that you are not losing out on affection and sharing it. You give me much hope . 16 yrs past RT and you’re only 57 . A year younger than I.Man you are young but you were so young to start this grand voyage . Inspiring .. Thanks as always for posting .

AlanMeyerModerator in reply to Hidden

I'm now 73. It was the radiation treatment that was at age 57.

Hidden in reply to AlanMeyer

Wow! I did Rt at 53 yrs old . Be well 🤙🏽

Had 6 months lupron ...45 rounds of rads...I'm 71 and back to near normal....sounds like with your numbers maybe eliminate the lupron.....My doctor said the HDR.was possibily over kill with my numbers...and slow stream..and I believe my numbers higher than yours ....been 3 years and the sex is good .... everything works well...good luck in your decision ...tough one ....peace

Thank you. I'll be sitting down with the urologist next week for the final decision.


I did double adt and Rt only and went into remission . Still have my prostate . Adt can work on pc very well. Side effects are real . But do is living . Good luck 👍 enjoy life !

Just to close out this thread, I've completed 28 sessions IMRT, 6 mo lupron and am on withdrawal. Sexually fully functional the full time. Castrate sex is interesting and fun to share with my wife.

You may also like...