Can Viagra work after prostate surgery or a biopsy for cancer?

Can Viagra work after prostate surgery? For some men, yes — but for fewer than in any other group studied. In sildenafil's studies, 43% of men who had had their prostate removed reported better erections, and the outlook depends on whether the nerves beside the prostate were spared. Recovery can take 18 to 24 months. A biopsy is different: erections dip slightly for about a month, then return to where they were.

How well does Viagra work after a radical prostatectomy?

Less well than for most men. Across sildenafil's studies, 43% of men who had had a radical prostatectomy said treatment improved their erections — the lowest of any group; the others ranged from 59% to 84% (EMA — Viagra product information). Australian Prescriber warns that men with "a history of pelvic surgery may not respond" to these tablets, and that a tablet should be taken as prescribed on five to six occasions before its effect is judged (Australian Prescriber). How often: how common is erectile dysfunction after a prostatectomy?

Does it matter whether the nerves were spared?

Yes. The prostate "is located next to the nerves, blood vessels and muscles that help you have an erection", and surgery can damage them; techniques that protect the nerves lower the chance that the damage is permanent. Age, your erections before surgery, other health conditions, "how well the nerves are preserved during surgery" and the recovery all shape the outcome, and "It can take between 18 and 24 months after prostate surgery for your erections to improve" (Healthy Male). Tadalafil's label adds: "It is not known if CIALIS is effective in patients who have undergone pelvic surgery or radical non-nerve-sparing prostatectomy" (EMA — Cialis product information). More in prostate cancer and impotence: causes, recovery and treatment.

When can you start, and does starting early help?

No Australian source we read sets a start date — not the removal of the catheter, not a number of weeks — so your urologist decides. Trials of "penile rehabilitation" — tablets taken regularly from soon after the operation — give a mixed answer. Nightly sildenafil from four weeks after nerve-sparing surgery, taken for 36 weeks, left 27% of men with erections good enough for sex without tablets, against 4% on placebo — but the trial stopped early and only 76 men finished (Padma-Nathan et al., Int J Impot Res 2008). In 423 men, daily tadalafil for nine months helped erections while taken, but six weeks after stopping, 20.9% on daily tadalafil, 16.9% on tadalafil as needed and 19.1% on placebo reached the target score without tablets (Montorsi et al., Eur Urol 2014). A Cochrane review of eight trials concluded that regular use "may not promote self-reported potency and erectile function any more than on demand use", on mostly very low-quality evidence (Philippou et al., Cochrane 2018). After other operations: can you take Viagra after surgery?

Does a prostate biopsy cause erectile dysfunction?

Briefly, for some men. In a biopsy, a urologist takes some cells from the prostate using a thin needle (healthdirect — prostate cancer). A review of nine studies found that erection scores on the IIEF-5 questionnaire fell by about 2 points a month after the biopsy and were back to baseline at three and six months (Fainberg et al., J Urol 2021); a second review agreed (Mehta et al., Urology 2021). If erections have not recovered by then, see your urologist.

What about radiotherapy and hormone therapy?

Both affect erections too: more than 3 in 4 men have trouble getting and keeping an erection after surgery, radiation therapy or androgen deprivation therapy (ADT), and ADT "may reduce your sex drive" (healthdirect — prostate cancer). Men after radiotherapy were "not well represented or excluded" from sildenafil's studies (EMA — Viagra). And a tablet cannot replace desire: "VIAGRA will not increase your sex drive and will work only if you are sexually excited" (Viagra CMI).

Is Viagra safe after prostate cancer treatment?

The usual rules apply. Never take it with nitrates for angina, which can cause "a sudden drop in your blood pressure that is hard to treat"; take no more than one tablet in 24 hours; and an erection lasting more than 4 hours needs the nearest hospital emergency department (healthdirect — sildenafil). Whether it affects your PSA or the cancer's return: does taking Viagra increase the PSA level?

What if tablets don't work?

There are other options. Penile injections tend to be used when tablets fail and work within 10–15 minutes; vacuum devices suit any man with erectile dysfunction "but more so for those with diabetes, spinal cord injury or after prostatectomy"; and a penile implant works "no matter the aetiology or severity", though "it is irreversible" (Australian Prescriber). Healthy Male adds a reminder that "you can orgasm without an erection". More on penile implants and the other options in how to overcome erectile dysfunction after prostate surgery.

The short answer

Viagra can work after prostate surgery, but for fewer men than usual — 43% in its studies — and the nerves matter. Give it five to six tries, and allow up to two years for recovery. A biopsy lowers erections only briefly. Every operation is covered in our guide to erectile dysfunction after surgery.