Patients who have surgery as their primary treatment for prostate cancer know that after their surgery they will have lost the ability to ejaculate at orgasm — making orgasm feel very different to their prior experience. It has not been so clear that — over time — the same applies to most radiation therapy patients.
A presentation from the annual meeting of the American Urological Association (AUA) that few appear to have noted at the time of the actual meeting has just been featured on Medscape. Stember et al. reported at the meeting on data from 364 consecutive patients treated with various types of radiotherapy and followed for an average (mean) of 6.0 ± 4.5 years. As indicated, Medscape has offered a summary of the actual presentation.
Here are the basic data presented by Stember et al.:
- 252/364 patients were treated with external beam radiation therapy (EBRT) and most of these patients (n = 225) receive intensity modulated radiation therapy (IMRT).
- 112/364 patients were treated with brachytherapy, of whom 84 received brachytherapy only and 28 received a boost of EBRT.
- The average age of the patients was age was 64 years (range, 42 to 78 years).
- 262/364 patients (72 percent) had lost the ability to ejaculate in a normal (“antegrade”) manner at the time of their last follow-up visit to the clinic.
- The proportion of patients experiencing inability to ejaculate (“anejaculation”) at 1, 3, and 5 years after radiation therapy was 16, 69, and 89 percent, respectively.
- Orgasm domain scores decreased dramatically over the follow-up period (for men who completed at least two of the relevant questionnaires): from 7.4 at < 12 months follow-up to 2.8 at > 36 months of follow-up.
- The probability of anejaculation appeared to be higher in men who received combination therapy (brachytherapy + EBRT), were of older age, and had smaller prostates.
The authors concluded that, “The vast majority of men after prostate RT will experience anejaculation and should be counseled accordingly prior to undergoing therapy.”
Quoted in the Medscape article referenced above, Dr. John Mulhall, the senior author of this study stated that, “Anejaculation is an inevitable and well-recognized sequela of radical prostatectomy and may represent a significant source of bother and sexual dissatisfaction. Loss of ejaculation or a severe decrease in ejaculate volume has been associated with a self-reported deterioration in sexual activity.” It seems likely, however, that at least some men are choosing to have radiation therapy over surgery because of a mistaken impression that they will retain normal ejaculatory function. Anejaculation after radiation therapy appears to have been significantly under-reported in the medical literature in the past, and the published data on this issue are few and far between. Clinical experience — by contrast — suggests that this is a common consequence of pelvic radiation therapy.