There is a widespread misunderstanding that radiation therapy as a treatment for localized prostate cancer will allow the patient to have or recover normal ejaculatory function after treatment. Let us be very clear that this is not usually the case at all.
A new study by Sullivan et al. has helped to confirm the accuracy of this statement.
Within the Sexual and Reproductive Medicine Program, which is part of the Urology Service at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York of the sexual health evaluation for post-RT patients, men are routinely evaluated after their treatment for localized prostate cancer and are provided with information regarding their ejaculatory function and orgasm.
Sullivan et al. carried out an analysis of their database in which they excluded all men with a prior history of radical prostatectomy, cryotherapy, focal therapies, and androgen deprivation therapy (ADT). In other words, they isolated the patients who were treated with some forms of radiation therapy.
Here are the results of their analysis:
- The basic data included 364 consecutive patients.
- 252/364 patients (69.2 percent) had been treated with external beam radiation therapy (EBRT)
- 112/264 patients 30.8 percent) had received brachytherapy (BT).
- The average (mean) age of the patients was 64 ± 11 years (range, 42 to 78 years).
- The mean follow-up after RT was 6 ± 4.5 years.
- The mean prostate size at time of radiation therapy was 42 ± 21 g.
- 262/364 patients (72 percent) had lost the ability to ejaculate in an antegrade fashion after prostate radiation therapy by the time of their last visit to the sexual and reproductive medicine clinic.
- 16 percent had experienced anejaculation at 1 year post-therapy.
- 69 percent had experienced anejaculation at 2 years post-therapy.
- 89 percent had experienced anejaculation at 3 years post-therapy.
- For men completing at least two International Index of Erectile Function (IIEF) questionnaires, orgasm domain scores (which range from 0 to 10) decreased dramatically over the follow-up period.
- At < 12 months post-therapy, the orgasm domain score averaged 7.4.
- At 13 to 24 months post-therapy it averaged 5.4.
- At 25 to 36 months post-therapy it averaged 3.2.
- At >36 months post-therapy it averaged 2.8.
- Factors predictive of anejaculatory status included older age, concomittant ADT, radiotherapy dose > 100 Gy, and smaller prostates at the time of radiation therapy.
Sullivan et al. conclude that “The vast majority of men after prostate [radiation therapy] will experience anejaculation and should be counseled accordingly prior to undergoing therapy.”
Many patients are apparently under the impression that radiation therapy only affects the cancerous cells in their prostates and that the normal (“healthy”) cells will be unaffected by radiation therapy. This is simply not the case.
Radiation of the prostate is designed to kill all cells in the gland if at all possible. It therefore has the same effect on the functioning of the prostate as radical surgery because (to all intents and purposes) there should be no living prostate tissue a year after the radiation is complete. The reason that there almost always is a small amount of living prostate tissue is that the radiation commonly does not, in fact, kill all of the normal prostate cells, which is also why PSA levels do rise slightly after first-line radiation therapy and don’t drop to undetectable levels. However, the amount of living prostate tissue that remains is normally far too small to permit normal ejaculatory function and normal orgasmic function.