Eighteen months after surgery to remove his cancerous prostate gland, Mark Roberts, 52, a former soldier, is ‘incredibly grateful’ that the disease was picked up by a private wellness screening offered by his employer.

Although his cancer was caught early – it was stage two, meaning it hadn’t spread beyond the prostate – it was affecting the whole of the right side of the gland.

He is, however, still struggling to come to terms with the side-effects of his treatment.

‘I haven’t managed to have sex with my wife yet as I can’t maintain an erection, and I still have issues with incontinence if I’ve been drinking beer,’ says Mark, a health and safety adviser, who is married to Karen, 49, a carer.

The couple, who live in Southport, ­Merseyside, have been together for 11 years and have five grown-up children between them from previous relationships.

‘It takes a lot to admit these side-effects publicly – there’s still a big taboo about talking about them,’ says Mark.

‘I feel that men are sometimes unprepared for what can happen after the surgery and don’t get enough support afterwards. It’s been one hell of a shock for me.

‘Some days I haven’t felt like a man. It puts a lot of pressure on us – as a couple – mainly because at first I wouldn’t talk about it to my wife. I felt too embarrassed and ashamed.’

He says his surgeon mentioned the ‘possibility of side-effects’ and he was given a leaflet.

‘But I’m guessing, like most men in my ­position, I was more concerned with getting the cancer removed as quickly as possible than what came afterwards.’

Mark would not want to put off anyone being treated – and acknowledges that in a sense he is one of the lucky ones because his cancer was ­spotted early.

The Daily Mail has long ­campaigned for a national ­prostate cancer screening programme, to detect a disease that now claims more lives each year than breast cancer (for which there is a screening programme).

Indeed, a major study last month found screening men for prostate cancer cuts their risk of dying from the disease by 13 per cent, with one such death prevented for every 456 men checked.

Together with the charity ­Prostate Cancer Research, the Daily Mail has been calling for screening initially to be targeted at men who are at greater risk (such as those with a family ­history of the disease or who are from certain ethnic backgrounds).

The campaign has been backed this week by former Prime ­Minister David Cameron, who has revealed that he was treated for prostate cancer last year. This comes as the UK’s National Screening Committee is due to report on Thursday on its decision whether to roll out ­widespread screening.

‘Earlier detection of prostate cancer can mean men have more choice over which treatment they have, and some of these ­techniques have lower rates of erectile dysfunction and incontinence,’ says David James, director of patient projects and influencing at Prostate ­Cancer Research. There are also steps men can take to minimise the side-effects – if they know about them.

Prostate Cancer Research is now calling for more ‘prehab’ and ‘rehab’ support for men under­going prostate surgery. This includes pelvic-floor ­exercise instruction before and after ­surgery, plus information on drugs and devices that can help with impotence – and counselling, if needed.

David James says: ‘Pelvic-floor exercises, tailored fitness programmes, libido-boosting drugs [such as Viagra or Cialis], sexual-­health devices for erectile problems and good emotional support can all make a real difference.’

When it comes to training ­pelvic-floor muscles, men should be educated about this ideally four weeks before surgery, and immediately after catheter removal (usually seven to 14 days after the operation), under guidelines from the European Association of Urology and the American Urological Association.

Research supports its benefits: a 2023 study in the Journal of ­Cancer Research and Clinical Oncology found that men who ­followed an exercise regimen three times a week for pelvic-floor muscles before surgery were less likely to suffer problems afterwards (more on this later).

The problems can occur because prostate surgery, while life-saving, can stretch, bruise, or compress nerves that control erections – or cause inflammation, which impairs nerve function. Scar ­tissue may also constrict nerves.

While nerve damage may last weeks or months, function can be gradually restored, but if nerves are completely severed it can take much longer to recover – if ever.

And because the prostate is close to nerves and muscles that control urination, the surgery can also damage bladder control – causing embarrassing leaks.

While nerve-sparing surgery (by a surgeon or a robot-assisted ­surgical system) is an option, it’s not available to – or suitable for – all men, especially if the cancer has spread or is more aggressive.

Similarly, radiotherapy, brachy­therapy (where radioactive seeds are injected into the prostate to kill the cancer) and hormone treatments – usually for advanced prostate cancer – can also lead to impotence.

One way to avoid complications such as erectile dysfunction and incontinence is with focal therapy – an umbrella term for treatments that more precisely target areas with the most significant cancer rather than the whole prostate.

‘Doing this avoids damage to the surrounding tissue and reduces side-effects such as erectile ­dysfunction and urinary ­incontinence,’ says David James.

‘They aren’t suitable for every man with prostate cancer – if their cancer is more extensive and has spread, for instance – but we’d like to see more men who are suitable for it given the choice.’

Other forms of focal therapy include cryotherapy (where the cancer is destroyed by freezing), and high-intensity focused ultrasound (HIFU, where high-­frequency sound waves are used to kill the cancer).

Another technique, irreversible electroporation (IRE) – sometimes called Nanoknife – uses high-voltage electrical pulses to destroy tumour cells: ­needles are placed around the tumour to deliver the electrical pulses to destroy it. This is the treatment David ­Cameron had.

A study published in the British Journal of Urology in 2022 found that after five years, the survival rate (where the cancer hadn’t returned) for men treated with Nanoknife was 98 per cent.

Meanwhile, just 2 per cent still suffered urinary incontinence, while the number of men who had erections sufficient for intercourse fell from 71 per cent before treatment to 58 per cent.

David Ralph, a professor of ­urology at University College ­London, says the risk of side-­effects is lower with focal therapy because the treatments are ­targeted at the cancer – but there may be a risk that not all the ­cancer is caught. ‘That’s why men often ask for the whole prostate to be removed,’ he adds.

Focal therapy is available on the NHS only in major prostate cancer centres – mostly in London and the South-East of England under arrangements set by the National Institute for Health and Care Excellence (NICE).

Side-effects are an issue that are likely to affect more men – around 63,000 a year in the UK are diagnosed with prostate cancer, and the number of prostatectomies is rising: in England alone it’s up from 7,477 in 2022 to 8,760 in 2023, compared to 5,000 a year back in 2010, according to the National Prostate Cancer Audit.

This is partly because of an increase in cases but also because of the development of robot-­assisted and minimally invasive surgical techniques, which ­promise to reduce the risk of nerve damage.

Mark’s cancer was diagnosed after a prostate-specific antigen (PSA) test, a blood test for a ­protein produced by the prostate. High levels can indicate cancer, but can also point to an enlarged prostate, an infection or reflect recent ejaculation.

After two tests revealing his PSA levels were 14mcg/L and 14.9mcg/L (a normal level for a man of 50 is up to 3.5mcg/L), he had biopsies – these confirmed he had cancer in the entire right side of his ­prostate. He was given the option of a robotic radical prostatectomy or radiotherapy.

‘They said that with robotic ­surgery there was less chance of nerve damage and erectile ­dysfunction,’ says Mark. ‘I was given leaflets and a website link – but I must admit I didn’t spend much time researching it; I just wanted the cancer gone.

‘In my head I couldn’t have ­prostate ­cancer if I didn’t have a prostate. Five months after surgery I still couldn’t have sex, even when using Viagra – which gave me headaches – and a penis pump, which didn’t work for me.

‘I left it for months, but it really got to me. I didn’t want to risk the embarrassment of not being able to get an erection again.

‘I didn’t go back to the urologist and the follow-up calls from the nurses petered out after ten months. I had a check-up and phone calls from the nurses. They told me not to attempt to have sex for the first few months until all the wounds had healed, and then to see if I had any nerve ­damage. And that was about it – there was no rehab as such.’

A study of 2,030 men who had a radical prostatectomy, published in the journal European Urology Open Science in 2024, found that as many as 83 per cent who could get erections without drugs or pumps prior to surgery, could not do so one year after the operation. And one in three men reported wearing pads for urine leakage after the procedure.

Professor Ralph says men need to be made fully aware of the impact a prostatectomy can have.

‘Treatment regret is a real issue,’ he says. ‘Many men are not ­prepared for how much surgery or radiotherapy can affect their ­intimacy. Better pre-treatment counselling and rehabilitation could prevent a great deal of ­distress.

‘Men are often overlooked when it comes to recovery after prostate cancer. We focus, rightly, on curing the disease, but far less on how men live afterwards – and that includes their sexual function, confidence and relationships.

‘In other areas of medicine, rehab is seen as essential. If you had knee surgery, for instance, you’d expect a structured rehab plan afterwards. When it comes to sexual function, too often men are left to cope alone – and that needs to change.’

David James says studies have shown a good recovery rate over time after a prostatectomy.

‘I speak to a lot of men who have side-effects and of course they are frustrated by them,’ he says.

‘But when weighed up against the risk that the cancer might have spread to their bones and killed them, it’s not a sacrifice they happily want to make. They would rather spend time with their loved ones and still be alive.’

Just how effective prehab and rehab can be is highlighted by the experience of Dr Peter Law, 79, a diabetes specialist who has treated men with erectile problems (which is common in men with diabetes, as high blood sugar can damage nerves and blood ­vessels involved in erections).

Dr Law (a pseudonym) – who was diagnosed with prostate cancer last year and underwent a prostatectomy nine months ago – used his medical knowledge and 15 years’ experience, to devise his own prehab and rehab plans.

‘I knew from treating hundreds of these men that incontinence and erectile dysfunction could be problems after prostatectomy,’ says Dr Law. ‘I wanted to get rid of the tumour with the least ­consequences – the ability still to have sex and be continent was important to me.’

Dr Law prepared for surgery by making sure he was fit as possible by walking 20,000 steps a day, swimming daily, twice-weekly yoga and gym sessions – and ­practising pelvic-floor exercises five times a day for a month.

‘I also took a long-acting PDE5 inhibitor drug [5mg Cialis] daily for a month before and after ­surgery, which was important as it encouraged night-time erections to come back,’ says Dr Law.

‘Generally, men need about 40-50 minutes of night-time ­erections. If you lose those then the smooth muscle in the penis gets replaced by collagen [a fibrous protein that provides structural support in the penis, but excessive amounts can impair erectile function].’

Dr Law also used a vacuum device several times a week after the surgery to boost blood flow into the penis, which reduces penile shortening (by gently stretching tissue and preventing scarring) that sometimes ­happens after surgery.

He also used a handheld device called Vertica, which uses radio­frequency energy to gently restore blood flow and nerve function to the penis. The device, which is not available on the NHS, costs £1,275. It has to be self-administered for 30 minutes to the penis and 30 minutes to the perineum (the area between the rectum and the scrotum) three times a week.

Dr Law stopped using the ­vacuum device and Vertica after six months, when his erections returned to normal.

He says that, as a result of his regimen, he has experienced ­minimal side-effects after surgery, has been able to resume his sex life and doesn’t have incontinence. He adds: ‘I worry about men who don’t get this information, because it’s awful – you don’t feel like a man when it happens.’

Professor Ralph adds: ‘For years we’ve relied on pills and pumps – they can help, but they don’t repair the underlying problem.

‘What’s exciting now is the development of technologies that may support genuine recovery rather than provide a quick fix. Vertica hasn’t yet been trialled in men recovering from prostate surgery, but if studies show ­benefits, it could be revolutionary.’

Meanwhile, Mark admits to sometimes wondering whether he should even have had the prostatectomy, especially as he’d had no symptoms and it was only picked up by a private wellness screening. As his libido nose-dived, he worried about his marriage.

‘Sex was a big part of our relationship and suddenly it was gone – and I couldn’t talk about it,’ he says. ‘I thought my wife would be better off with someone else.’

But the couple say they have grown closer after he finally admitted his feelings and he is now using Vertica to improve his condition. Mark says he’s ­confident that their sex life will resume.

He says: ‘Of course, ultimately, I don’t regret my surgery – it cured my cancer. But I do wish I’d been better prepared and supported for what came next.’

• Prostate Cancer Research has compiled real-life stories from 1,000 men about their experiences of prostate cancer. Visit: theinfopool.co.uk