Sexual difficulties are one of the most common, distressing, and persistent treatment-related challenges for men diagnosed with prostate cancer, often under-recognized and poorly managed. Many men who have received prostate cancer treatment have unmet sexual care needs that remain over time, with these needs further exacerbated by men’s reluctance to seek help for their sexual concerns. We explored this reluctance by surveying men diagnosed with prostate cancer who received an active treatment (radical prostatectomy or other non-hormonal treatment) at two time points and asked them about their sexual help-seeking intentions and behaviors, and unmet sexual care needs.